Clinical approach for gastric submucosal tumors of 2 cm or less in diameter

The clinical approach for gastric submucosal tumors (SMTs) of 2 cm or less in diameter is discussed by reviewing previous reports. In the case of gastrointestinal stromal tumor (GIST) among SMTs, even if it is 2 cm or less in diameter, although rare, it may rapidly enlarge in size and will likely become malignant, and therefore it is necessary to remove it through a method such as laparoscopic and endoscopy cooperative surgery (LECS). Generally, under esophagogastroduodenoscopy (EGD), if an SMT is found to be stiff by touching with forceps, there is a high possibility that it is a gastrointestinal mesenchymal tumor (GIMT), and it would be necessary to follow the tumor once or twice a year according to the guidelines. The diagnosis of GIMT can be made by endoscopic ultrasound (EUS), and therefore it is recommended that EUS be performed at least once. However, EUS-fine needle aspiration (EUS-FNA) should be performed in cases where uneven internal echo, border irregularity, cystic degeneration, high-echo spot, and other findings suspicious of GIST are found on EUS, or in cases where surgical indication should be judged due to an increase in size to more than 2 cm during follow-up.